|Year : 2015 | Volume
| Issue : 2 | Page : 39-45
Pattern of road traffic injuries in patients admitted to Al-jlaa Hospital, Benghazi, Libya
Ashraf Mahmoud Emara1, Azza S.H. Greiw MD 2, Neven Ahmed Hassan1
1 Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, Tanta, Egypt
2 Department of Family and Community Medicine, Faculty of Medicine, Benghazi University, Benghazi, Libya
|Date of Submission||10-Aug-2014|
|Date of Acceptance||18-Feb-2015|
|Date of Web Publication||3-Jun-2015|
Azza S.H. Greiw
Department of Family and Community Medicine, Department of Faculty of Medicine, Benghazi University, Benghazi
The developing countries bear a large share of burden and account for about 85% of the deaths as a result of road traffic accidents. In Libya, accidents cost the country about $160 million in 1978. The factors that affect accident rates and severity are divided into behavioral and structural ones. The present study was carried out to determine the incidence of fatal vehicular accidents and patterns of injuries among road traffic injury victims brought to Al-jlaa Hospital (Benghazi, Libya). A total of 2630 patients with road traffic injuries were registered at Al-jlaa Hospital. The data reported in the present study were collected between January 2009 and December 2009. Data were collected, including medical history, patient symptoms, clinical signs, and the radiological findings. A systematic method was used for the clinical examination of the traumatized region. Data of patients were recorded, including age, sex, time of occurrence, types of road users, frequency and type of injury (frequency of soft tissue injuries and bone fractures), outcomes, ICU admission, duration of survival as well as the period of hospitalization until death. Furthermore, an optimal combination of radiographic imaging was ascertained and computed tomography was found to be the single most informative mode of imaging. The Glasgow Coma Scale was used to assess the severity of brain injury. The Abbreviated Injury Scale scorings were performed according to the guidelines in the Abbreviated Injury Scale 2005 edition. A conservative or an operative intervention performed for all the cases was also recorded.
Keywords: injuries, Libya, road traffic injuries
|How to cite this article:|
Emara AM, Greiw AS, Hassan NA. Pattern of road traffic injuries in patients admitted to Al-jlaa Hospital, Benghazi, Libya. Tanta Med J 2015;43:39-45
|How to cite this URL:|
Emara AM, Greiw AS, Hassan NA. Pattern of road traffic injuries in patients admitted to Al-jlaa Hospital, Benghazi, Libya. Tanta Med J [serial online] 2015 [cited 2020 Jul 3];43:39-45. Available from: http://www.tdj.eg.net/text.asp?2015/43/2/39/158045
| Introduction|| |
Road traffic injuries account for 2.1% of mortality worldwide. The developing countries bear a large share of burden and account for about 85% of the deaths as a result of road traffic accidents  . Thus, the problem of road traffic accidents is becoming a major concern. The WHO has predicted that traffic fatalities will be the sixth leading cause of death worldwide and the second leading cause of disability-adjusted life-years lost in developing countries by the year 2020  .
Motor-vehicle accidents are complex events resulting primarily from human, technical, and environmental contributing factors. Continuous growth in the number of motor vehicles, increase in population, and poor access to healthcare as well as excessive speeding and use of alcohol and other drugs are major factors that influence the frequency and severity of motor-vehicle collisions in urban areas  .
Identification of the most probable factors that affect the severity of accidents is the basis for effective road traffic accident prevention. Traffic police have the responsibility of collecting and analyzing crashes, and a review of motor-vehicle collisions can be compiled from their reports  . Al-Ghamdi  analyzed pedestrian-vehicle crashes in Riyadh, Saudi Arabia, using data from traffic police reports. In addition, data on the type of injury, injury severity, costs, and length of hospital stay were collected from hospital records. The most complete information on causalities in road traffic crashes can be obtained from linked police, hospital, and death records  .
In Libya, accidents cost the country about $160 million in 1978. The factors that affect accident rates and severity are divided into behavioral and structural ones  .
Sight obstruction is the evident cause of driver error if vision was impaired at the time of the accident by buildings, plants, or other objects, particularly parked, stationary, or moving vehicles. Masked stimuli are considered to be the main factor if there is an evidence of adverse weather conditions. This includes (heavy) sleet, rain and snow, fog, and/or dusk or darkness, but also if the driver is being dazzled by the sun or other vehicles. The failure to notice oncoming vehicles or relevant traffic signs is a significant reason for not using the information correctly, frequently associated with inattention. This may be caused by distraction, including secondary activities in the vehicle such as conversations, phone calls and operating devices, objects or events outside the vehicle that are not related to the driving task, or internal distraction, such as negative emotions or stress. If the driver observes the traffic or traffic-relevant information, but not that which is relevant for carrying out the planned maneuver, his or her attention is not focused accurately. This may be because of information overload (e.g. when the driver is not familiar with the traffic situation) or deficits in selective attention on the driving task  . The present study was carried out to determine the incidence of patterns of injuries amongst road traffic accidence (RTA) victims brought to Al-jlaa Hospital, Benghazi, Libya.
| Participants and methods|| |
A total of 2630 patients with road traffic injuries were registered and admitted at Al-jlaa Hospital. The data reported in the present study were collected between January 2009 and December 2009 from the patient's file or forensic medicine records. Data were collected, including medical history, patient symptoms, clinical signs, and the radiological findings. A systematic method was used for the clinical examination of the traumatized region. Data of patients were recorded, including age, sex, time of occurrence, types of road users, frequency, and type of injury (frequency of soft tissue injuries and bone fractures), outcomes, ICU admission, duration of survive as well as the period of hospitalization until death. Furthermore, an optimal combination of radiographic imaging was ascertained and computed tomography was found to be the single most informative mode of imaging in all altered mental state patients. The Glasgow Coma Scale was used to assess the severity of brain injury. A conservative or an operative intervention performed for all the cases was also recorded. The Abbreviated injury severity scale (AIS) scorings were performed according to the guidelines in the AIS 2005 edition. The AIS is a scale for the categorization of injury type and severity. The body is divided into six regions (i.e. head or neck, face, chest, abdomen, extremities, and external body area) in which injuries are graded from 1 (minor) to 6 (clinically untreatable). The maximal AIS, which is the highest single AIS code in a patient with multiple injuries, was determined. The ISS, which is useful for the assessment of the severity of multiple injuries, is the sum of the squares of the highest AIS code in each of the three most severely injured body regions  .
| Results|| |
2630 cases involved road traffic injuries and none of the occupants and drivers were using a seat belt; 80.9% of the victims were males, whereas 19.1% were females. Of the victims who died, 88.5% were males and 11.5% were females [Table 1].
|Table 1 Distribution of the cases studied according to their sex, age, months, and types of road use|
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The age of the victims who survived and those who died ranged from 1 to 90 years. In the group of victims who survived and died, the age group between 21 and 30 years was the most vulnerable (n = 785, 31.2% and n = 70, 57.4%, respectively), followed by the age group 31-40 years (n = 500, 19.9% and n = 25, 20.5%, respectively) and 11-20 years (n = 433, 17.3% and n = 11, 9.0%, respectively). Accordingly, the highest percentage of fatalities (86.9%) was in the age group of 21-40 years. Children younger than 10 years of age with the least number of fatalities comprised 2.4% of the total fatalities, followed by the age group of 51-60 years (4.1%) and the age group of those older than 60 years (6.6%) [Table 1].
Among the victims who survived, the maximum number of cases was observed in May (n = 263, 10.5%), followed by September (9.8%) and October (9.7%). The lowest number of cases was found in January (5.0%). However, among the victims who died, the maximum number of cases was observed in January (n = 55, 45.1%), followed by February (15.6%) and August (9.8%). The least number of cases was found in May (0%) [Table 1].
[Table 1] shows that passengers were among the largest group of victims of road traffic injuries and fatalities (39.3 and 40.2%, respectively), followed by drivers (34.6 and 23.0% respectively). The official statistics showed only a small proportion of the threat in Benghazi to bicyclist (0.02 and 7.4%, respectively) and a motorcyclist (0.08 and 9.8%, respectively).
[Table 2] shows that the most common injury was to the head, followed by the lower and upper limbs (21.8, 38.7, and 15.3%, respectively) in the victims who survived. Among the victims who died, head injuries were the most common (67.2%). A total of 547 surviving victims (21.8%), and 82 victims who died (67.2%) sustained head and neck injuries. Skull fractures were found in 205 (37.5%) victims who survived and 39 (47.9%) victims who died. The most common type of intracranial hemorrhage was an extradural hematoma among victims who survived and those who died (6.4 and 29.2%, respectively). Among other injuries in victims who survived, the most commonly injured abdominal organ was the urinary bladder (21.4%), followed by the liver (19.1%), the stomach and intestine (13.7%), and kidney (11. 5%).
|Table 2 Distribution of the cases studied according to the incidence of regional injuries|
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Skull fractures commonly involved multiple sites, 22.0%, followed by the parietotemporal area, 19.9%, base of the skull, 15.0%, and the occipital area, 10.1%. Fracture of frontal bone was recorded in only 3.3% of cases [Table 3].
|Table 3 Distribution of the cases studied according to the anatomical location of skull fractures|
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Consultations from other departments were requested. Consultation requests and the departments from which consultations were requested are shown in [Table 4].
|Table 4 Distribution of the cases studied according to the consultations requested for the victims according|
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According to the outcome of the cases studied, it was found that 82.3% were discharged to attend the outpatient department, 8.4% were discharged without permission, 3.3% were absconding, 1.1% were transferred to another hospital in Benghazi, 0.3% refused admission, and 4.6% died [Table 3]. Out of 2630 cases, 190 (7.2%) were admitted to the ICU [Table 5].
|Table 5 Distribution of the cases studied according to their injury outcomes, ICU admission, duration of survive, period of hospitalization until death, and Glasgow coma score at the time of presentation|
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Out of 122 victims, two (1.6%) died instantly and 98.4% died after a period of hospitalization. Out of the hospitalized victims, 23.0% died in the first 24 h, 48.3% died over a period of 1-10 days, 18. 0% died within 11-20 days, and 10.7% died over more than 21 days [Table 5].
A Glasgow Coma Score of 5 or less was found in 67.2% of the victims at the time of presentation at the emergency department of the hospital, whereas it ranged from 6 to 9 in 19.7% and was more than 10 in 13.1% [Table 5].
The cases studied were divided into six groups according to the abbreviated injury severity scale (AIS); the majority of patients scored AIS 1 (53.5%) and AIS 6 was scored the least (0.30%) [Table 6].
|Table 6 Distribution of cases according to the abbreviated injury severity scale|
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| Discussion|| |
Road traffic injury is one of the major causes of hospital admission in Libya, and is responsible for one-half of injury-related hospital admissions in primary-level and secondary-level hospitals.
Not surprisingly, our study shows that the overwhelming majority of the deceased victims (80.5% among surviving victims and 88.5% among those who died) were males. This predominance of males has been attributed to the fact that the drivers were predominantly men (men normally work outside the home and are the primary income earners in the family), they tend to be more aggressive drivers, and also men were predominantly the drivers of commercial transport vehicles apart from private cars  . This is due to greater male exposure on urban streets and similar higher incidence of traffic accidents among males has been found by many other researchers ,, .
Studies in Nigeria, Mexico, Israel, Greece, and Italy have reported the leading cause of accidental injury and death in RTCs among individuals between 21 and 40 years of age ,,,, .
The most common age group affected in the study was between 21 and 40 years (n = 1380, 52.47%) and is consistent with the studies available from other countries ,, . This age range represents the most active phase of life, physically and socially, and hence outnumbers the other road users. They, therefore, account for the maximum number of accidental deaths. Considering the maximum involvement of individuals in the economically productive years, vehicular collision fatalities may have an important economic impact. Preventive measures targeting these high-risk groups are important to reduce the incidence of severe brain injuries.
Teenagers and young men in particular have a high proclivity for risky behavior, exemplified by speeding, neglecting seat belts, risk taking while driving, and night-time driving. Recent research by the Road Safety Authority  in Ireland states that young male drivers (17-25 years) are seven times more likely to be killed on Irish roads than other road users. Shope et al.  suggest that inexperience and risk taking are two factors that are associated strongly with collisions among young drivers.
Young people are most at risk after the consumption of alcohol because of their susceptibility to its intoxicating effects. This is mainly because young people have a lower tolerance to alcohol than older drivers. A variety of other factors such as muscle mass, speed of alcohol consumption, whether the individual has eaten before drinking, etc. According to research by Zador et al.  cited by Bedford et al.  , drivers older than 35 years of age were 11.4 times more likely to be fatally injured in a crash when their blood alcohol levels ranged from 80 mg/100 ml (Irish legal limit) to 100 mg/100 ml. However, for young drivers between 16 and 20 years of age, the relative risk of a fatal crash increases by 51.9 times when their blood alcohol concentration is within the 80 mg/100 ml to 100 mg/100 ml blood alcohol concentration range  .
The present study showed that there were fewer accidents among individuals younger than 20 years of age and those older than 49 years of age. The reasons may be that children are taken care of by the elders and because of the lower use of vehicles by adolescents. A lower proportion of RTAs in those 60 years of age and older could be because of the generally lower mobility of the individuals in this age range.
The maximum number of accidents (in survived cases) was observed in May (10.5%), followed by September (9.8%) and October (9.7%). The least number of accidents was observed in January (5.0%). This may be attributed to the beginning of schools and universities in September and October; the large number of accidents in May may be because of the end of the academic year and the beginning of exams. However, considering the victims who died, the maximum number of accidents occurred in January, followed by February. This may be attributed to raining and uncontrolled break  .
The present study showed that passengers constituted the largest victim group of road traffic accident injuries and fatalities (39.3 and 40.2%, respectively), followed by drivers (34.6 and 23.0%, respectively). The official statistics indicated only a small proportion of the threat to bicyclists (0.02 and 7.4%, respectively) and motorcyclists (0.08 and 9.8%, respectively). The previous results may be explained by investigations into some aspects of driver behavior in some affluent developing countries, which indicate that drivers acquire many dangerous and harmful driving habits and that driver compliance with traffic regulations is poor. A recent study showed that in most Gulf Countries such as Sultanate Oman, Kuwait, Saudi Arabia, and United Arab Emirates, the seat belt law is ignored , .
Fédéération Internationale de l'Automobile  reported that in OECD countries alone, it is estimated that 9000 individuals between 16 and 24 years old were killed on the roads in 2003 (in car crashes). Possible solutions to this problem have included graduated licensing schemes that place additional restrictions on young drivers.
Prehospital mortality was found in two cases (1.6%). The rest (98.4%) of the victims were taken to the hospital, where they later succumbed to their injuries. This is almost in agreement with the study carried out in Iran, which found higher cases of prehospital mortality  .
Glasgow Coma Scoring of head injury at the time of presentation to the emergency department is an important prognostic factor and the level of consciousness should be determined and monitored regularly in all such patients  . In the present study, 67.2% of the victims had a Glasgow Coma Score lower than 8 at the time of presentation and 71.3% died within 10 days of sustaining the injury. A similarly result was reported in the study of Sharma et al.  .
The present study observed that the most frequent lesions were in the lower limb (38.7%), followed by the head and neck (21.8%) among the victims who survived. However, among the victims who died, the most frequent injuries were observed in the head and neck (67.2%). The most common injury in similar studies was in the head (69.63%), followed by the chest (33.62%)  . However, another study reported that in the city of Tel Aviv, Israel, the trunk was the most commonly injured body part  .
The most common intracranial hemorrhage was subdural hemorrhage (1.91%), which is consistent with the findings of other researchers ,,, .
Seatbelt restraints play an important role in the reduction of fatalities and of the severity of injuries in the vehicle. Unfortunately, our study found that seat belts were not used. In the USA, front seatbelt use was reported in 2002 at a 75% rate, and the rates in European Union countries were between 45 and 95% among front-seat occupants and between 9 and 75% among rear-seat passengers. In the Republic of Korea, rates of seatbelt usage increased markedly among drivers, from 23% in late 2000 to 98% in August 2001, following a national campaign. In many other places, usage rates are generally much lower. For instance, in Argentina, front seatbelt use is ~26% in the capital, Buenos Aires, and 58% on national highways. It was found that among over 200 road collision survivors, only 1% reported seatbelt use in Kenya  .
To minimize traffic accidents, the following recommendations should be taken into consideration: teaching of traffic rules starting at a very young age, reminding these rules frequently through the print media and other means of information with the purpose of reinforcing these rules, training and courses for drivers to provide them with complete information, subjecting professional drivers driving mass transport vehicles to health controls and psychological tests, and reminding individuals of the benefits of using safety belts and helmets; all these should be included in the training activities. Accidents can also be minimized by avoiding excess speed, not ignoring crossing signals, and avoiding unsafe overtaking and unsafe U turns (turning the vehicle 180°). Compulsory use of seat belts by the drivers and passengers of automobiles and the wearing of crash helmets by bicyclists and motorcyclists can help reduce road traffic-related deaths significantly.
Each hospital must establish a committee on road traffic injuries-related fatalities to address deficiencies and errors in the management of the victims who arrive alive to the hospital.
| Conclusion|| |
This study shows that most of the deaths of victims of road traffic accidents, brought to a tertiary care hospital, take place either on the spot or within 24 h of injury, which is very alarming, and highlights the need to take urgent steps to establish good pre-hospital care and to provide trauma services. Our study also shows that head injuries remain the most common and serious type of trauma encountered in the emergency department of our hospital and the availability of good neurosurgical care is essential for these patients. A nationwide computerized trauma registry is urgently required to shed light on the risk factors, circumstances, and the chain of events leading to the accidents and will be very useful in policy making.
In short, it has been shown in this study that male sex, young age, and involvement of passengers and drivers and pedestrians pose a higher risk, mortality, and morbidity. Our results may be useful for forensic pathologists and clinicians and for mechanical engineers who investigate new safety devices for vehicle occupants.
Deaths, injuries, and disabilities as a result of traffic accidents place a huge financial burden on the budgets of developing countries such as ours.
Limitations of this study
There were other factors that were not studied that might have an influence on the total number of fatalities, for example the ambulance response times, and the quality of care delivered prehospital and in the hospital.
The presence of alcohol or substance abuse as a causative factor of fatalities was not available for analysis.
Use of seat belt and time and day of maximum injuries were also deficient.
| Acknowledgements|| |
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]